Florida Regulations 69L-3.003
§ 69L-3.003 Procedures for Filing Documents.
(2) Claims-handling entities shall respond to any written request for information by the Division no later than 14 days after receiving the request, except as otherwise provided in Chapter 69L-3, F.A.C.
(3) The claims-handling entity, where required, shall include on every document it submits to the Division the following information:
(a) The employee's name. (b) The employee's social security number as assigned by the Social Security Administration. If the employee does not have a social security number, the claims-handling entity shall contact the Division following the instructions provided on the following website: www.fldfs.com/WC/organization/odqc.html (under Records Management - Division Assigned Numbers) to obtain a Division assigned number until the social security number is obtained. Upon receipt of the employee's social security number, the claims-handling entity shall file Form DFS-F2- DWC-4, as adopted in Rule 69L- 3.025, F.A.C., with the Division in accordance with Rule 69L- 3.0091, F.A.C. (c) The month, day, and year of the employee's accident or illness, in the following order: mm-dd-yy or mm-dd-ccyy. (d) The "Insurer Code #". A claims-handling entity adjusting claims for one or more insurers shall report the correct "Insurer Code #" for each specific claim. (e) The "Service Co/TPA Code #". If a third-party administrator, servicing agent, or other claims-handling entity is servicing a claim for an insurer, self-insured employer or self-insurance fund, it shall include both the "Insurer Code #" and the "Service Co/TPA Code #" on any form. (f) The "Claims-handling Entity File #". A claims-handling entity shall report its internal identification number assigned to a file on forms as required under this chapter. (g) The name, address and telephone number of the claims-handling entity. When a "Service Co/TPA" is adjusting claims for an insurer, the name, address and telephone number of the "Service Co/TPA" in addition to the name of the insurer shall be provided. The telephone number provided shall enable a caller to readily contact the office handling the claim. (h) The "Sent to Division Date".
(4) The insurer or the claims-handling entity shall provide a supply of Forms DFSF2- DWC-1 and DFS-F2-DWC-1a, as adopted in Rule 69L- 3.025, F.A.C., to the employer, unless an alternative electronic reporting arrangement with the claimshandling entity is in place. The name of the insurer and the claims-handling entity's name, address and telephone number shall be pre-printed or pre-stamped on each such form.
(5) All submissions of forms promulgated under this rule shall conform with the promulgated form in design, layout, field size, content and shall contain all data elements required by the promulgated form. If the Division finds that a computergenerated form is not the same as the promulgated form, the Division will return the form and the claims-handling entity shall make the correction, include a revised "Sent to Division Date" and resubmit a corrected form to the Division. The document will be considered completed and in compliance with this section when the corrected document is resent to the Division and is accepted.
(6) Any insurer or claims-handling entity failing to timely send documents promulgated under this chapter is subject to administrative fines assessed by the Division.
Specific Authority 440.185(2), (5), 440.20(3), 440.207(2), 440.38(2), (5), 440.591 FS. Law Implemented 440.185, 440.20, 440.51(8), (9) FS. History-Originally numbered 38F-3.01, 3.02, 3.03, New 10-30-79, Amended 11-5-81, Formerly 38F-3.03, Amended 4-11-90, 1-30-91, 11-8-94, Formerly 38F-3.003, 4L- 3.003, Amended 1-10-05. History-New 1-10-05.